Changes in Shooting Incidence in Philadelphia, Pennsylvania, Between March and November 2020
This study uses police department registry data to describe trends in incidence of firearm shootings and deaths in January-November 2020, before and after the closure of nonessential businesses in March, the killing of George Floyd in May, and the partial lifting of containment policies in June. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Expanding COVID-19 Vaccination —Optimizing Use and Maximizing Efficacy
This Viewpoint proposes ways to maximize vaccine efficacy and allocation given the rise of coronavirus variants and authorization of a Johnson& Johnson vaccine, including reserving the latter for younger healthier populations, boosting it with a single-dose messenger RNA (mRNA) vaccination, and single mRNA immunization of people with prior documented SARS-CoV-2 infection. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

What the 2020 Election Means for the Future of Health Policy in a Partisan United States
This Viewpoint summarizes views measured in national opinion polls about COVID-19 response, national health insurance reform, reforming the US health care system in general, and race and race disparities in health, with a focus on differences between Democrat and Republican respondents and implications of those differences for enacting meaningful legislation. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Reinventing the Center for Medicare and Medicaid Innovation
This Viewpoint makes 6 recommendations for how the Center for Medicare and Medicaid Innovation, as it enters its second decade, can better fulfill its mission of testing health care payment and service delivery models and scale them up to a national level to reduce health care expenditures and improve quality and safety. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

JAMA Peer Reviewers in 2020
We sincerely thank the 2880 peer reviewers who completed manuscript reviews for JAMA in 2020. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Sitting in the River —Being With Patients May Be All We Can Manage
In this narrative medicine essay, a palliative care physician finds the space between professional and patient distance thinning as the COVID pandemic drags on and wonders whether abiding with them is the lesson. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Passing Out at the Hospital
It was foolish of me to swoon outside the room where your wife was going to die soon and end your natural life. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Patient Information: Giardiasis
This JAMA Patient Page summarizes risk factors, symptoms, diagnosis, and treatment of giardiasis, an intestinal parasite infection that can cause gastrointestinal symptoms including nausea, stomach cramps, and prolonged diarrhea. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Antimicrobial Use in a Cohort of US Nursing Homes, 2017
This cross-sectional survey assessed the risks of antimicrobial use among 15  276 nursing home residents across 161 facilities. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Low- vs High-Intensity Walking Exercise and Walk Distance in Patients With Peripheral Artery Disease
This randomized trial compares the effects of comfortable low-intensity home-based walking exercise vs high-intensity exercise sufficient to elicit ischemic symptoms vs nonexercise control on 6-minute walk distance among patients with peripheral arterial disease (PAD). (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Effect of Celecoxib vs Placebo With Adjuvant Therapy on Stage III Colon Cancer
This randomized trial compares the effect of adding celecoxib to standard adjuvant chemotherapy in improving disease-free survival among patients treated for stage III colon cancer. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Drugs for Atopic Dermatitis
This Medical Letter provides a Table summarizing key information about topical corticosteroids available for atopic dermatitis published as part of a comprehensive review on the topic. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk —Reply
In Reply The letter from Dr Olshansky and colleagues proposes several hypotheses to explain the different outcomes in the REDUCE-IT and STRENGTH trials. They suggest that the greater content of EPA (4 g/d) administered in REDUCE-IT produced superior results but also suggest that the results were replicated in JELIS, an open-label study that used only 1.8 g/d. If EPA dosage is the critical issue, then the 4 g/d administered in STRENGTH should have produced some benefit. These authors suggest a threshold effect, but for the top tertile of change in EPA in STRENGTH (>435% increase), there was no benefit. With respect to mi...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Whistleblowing and Misconduct at Large Pharmaceutical Firms —Reply
In Reply Data indicate that whistleblower incentives are an important way to reduce the incidence of illegal activities by large pharmaceutical firms. Incentivized whistleblowing in the US includes the False Claims Act ’s qui tam provision as well as a variety of other forms of whistleblowing. In response to our recent article, Dr Hashimoto and colleagues asked about the extent of whistleblowing activity in relation to financial penalties against large pharmaceutical firms in the US. We have now conducted dual-r ater content analysis of all press releases for state and federal settlements between January 2003 and Dec...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor The STRENGTH trial reported no benefit on cardiovascular events with omega-3 CA in contrast to a 25% reduction in REDUCE-IT and a 19% reduction in JELIS, an open-label study without placebo that used the same formulation of omega-3 ethyl ester as REDUCE-IT. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor Cardiovascular disease is a leading cause of mortality in Asia and hypertriglyceridemia is prevalent in Asian populations. We are particularly interested in the results of the prespecified subgroup analysis in the STRENGTH trial shown in Figure 3 of the article. This analysis revealed a significant reduction in the risk of the primary composite cardiovascular end point of 0.72 (95% CI, 0.54-0.96) among Asians and 0.78 (95% CI, 0.62-0.98) in the Asia region, which raises the possibility that administration of high-dose omega-3 fatty acids has cardiovascular benefits in Asian subgroups. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor The results of the STRENGTH trial showed conclusively that omega-3 CA, a carboxylic acid formulation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), did not improve cardiovascular outcomes compared with corn oil placebo. In contrast, REDUCE-IT demonstrated improved cardiovascular outcomes with 4 g/d of icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid, compared with a pharmaceutical-grade mineral oil placebo. Similarly, the randomized JELIS trial demonstrated a statistically significant decrease in major adverse coronary events with an even lower dose of icosapent ethyl, 1...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor I am concerned that the STRENGTH trial did not have adequate treatment adherence, as evidenced by plasma EPA and DHA levels that increased by 269% and 40%, respectively, after treatment with omega-3 fatty acids for 12 months. This increase was lower than expected because the authors had previously shown that treatment with the same omega-3 formulation at the same dose for 3 months increased plasma EPA and DHA by 406% and 72%, respectively. Another report demonstrated that treatment with a similar omega-3 formulation at the same dose for 2 months increased EPA and DHA by 402% and 86%, respectively. In addition...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Whistleblowing and Misconduct at Large Pharmaceutical Firms
To the Editor In their recent Research Letter, Dr Arnold and colleagues presented profiles of illegal activities and penalties paid by pharmaceutical firms in the US from 2003 to 2016. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018
This national survey study uses the National Health and Nutrition Examination Survey (NHANES) to describe trends in age at natural menopause, age at menarche, and reproductive life span, and variables associated with shorter and longer spans, among US women between 1959-1962 and 2015-2018. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

The Medical Profession and the Public
William J. Mayo, M.D., Rochester, Minn. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Thermal Imaging Systems May Pose Public Health Risks
Thermal imaging systems used to measure human body temperature in airports, workplaces, and other venues where COVID-19 may spread aren ’t accurate if used improperly and shouldn’t be considered a tool to diagnose the disease, according to an FDA safety communication. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

A First in Surgical Devices for Transvaginal Hysterectomy
A new robotically assisted surgical device designed to have a surgeon ’s dexterity has received FDA authorization for use in benign transvaginal procedures including benign hysterectomy. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

3D-Printed Implant Is Approved to Replace Ankle Joint Bone
The FDA has approved a 3-dimensional (3D) –printed implant designed to treat people with avascular necrosis (AVN) of the ankle joint. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

To JAMA Authors, Reviewers, and Especially Physician Readers —A Profound Thank You
The global COVID-19 pandemic continues to permeate virtually every aspect of society and daily life, including government, business, travel, education, and especially the health care system. With more than 120 million cases of SARS-CoV-2 infection worldwide, including nearly 30 million cases in the US, and with more than 2.5 million deaths worldwide, including more than 500  000 deaths in the US, health care systems, hospitals, physicians, other health care professionals, and researchers worldwide have been challenged like never before, not only to care for overwhelming numbers of severely ill patients with COVID-19, but...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Opportunities to Improve Antimicrobial Use in US Nursing Homes
Inappropriate use of antibiotic therapy is a major driver of adverse effects related to medications and antibiotic resistance in nursing homes. Despite formal calls for the enhancement of prescribing practices, along with improvements in structure and process, antibiotic stewardship in nursing homes remains suboptimal. Measuring antibiotic use in nursing homes and comparing observed patterns with relevant benchmarks is a core component of antibiotic stewardship. However, to date, nationally representative data to which nursing homes can benchmark have been lacking. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Celecoxib for Stage III Colon Cancer
Observational studies have linked aspirin and selective cyclooxygenase-2 (COX-2) inhibitors to prevention of colorectal adenomas and colorectal cancer, and reduction in recurrence following resection or improved survival for patients with advanced or metastatic disease. There are plausible mechanistic hypotheses linking inhibition of prostaglandin synthesis, nuclear factor κB activation, and the transcription factor RUNX1 to the anticancer effects of aspirin and celecoxib. In addition, there is evidence from a meta-analysis across multiple studies of the potential effects in terms of enhanced response rates when COX-...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Two Incomplete Author Names
This article was corrected online. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Update of Image Credit and Word Choice
This article was corrected online. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Errors in Results
The Original Investigation titled “Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients With Heart Failure With and Without Diabetes,” published in the April 14, 2020, issue of JAMA, included errors in the Results section. This included labeling weight decline in those with diabetes as weight d ecline in those without diabetes at 8 months, citing reference 18 rather than reference 16 in footnote “b” in Table 2, and not indicating that the absolute difference in cardiovascular death or hospitalization for heart failure among patients with diabetes was presented as a...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Group Name Omitted
This article was corrected online. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

“Self-Portrait as Exit Wounds”
This wordless graphic story conveys the loss and powerlessness felt by health care workers, patients, and families confronting the coronavirus pandemic, and was drawn by a community hospitalist as a tribute to each. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Evaluation of Hypokalemia
This case report describes the evaluation of a 52-year-old woman taking a thiazide diuretic with hypokalemia (potassium, 2.6 mEq/L) and hypertension (blood pressure, 159/94 mm Hg) and presents an algorithm for the diagnosis and management of underlying causes of low serum potassium levels. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

International Variation in Intubation and Extubation
Requiring invasive mechanical ventilation acutely outside an operating room is, for many, the definition of critical illness. Although there may be debate regarding whether patients treated with noninvasive ventilation or vasoactive infusions can be safely managed outside an intensive care unit (ICU), there is likely unanimous agreement that patients with an endotracheal tube should be cared for in an ICU. Understanding how invasive mechanical ventilation is provided is therefore essential to understanding one of the primary tasks in critical care medicine. In 2016, the Large Observational Study to Understand the Global Im...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Screening for Hearing Loss in Older Adults
In this issue of JAMA, in the updated Recommendation Statement on screening for hearing loss, the US Preventive Services Task Force (USPSTF) “concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in older adults (I statement)”; this recommendation is unchanged from the 2012 USPSTF review. The recommendations have important implications for the US population becau se the incidence of hearing loss increases substantially with age and the number of people 65 years or older is 54.2 million, which has increased by more than one-third (34%, or ne...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Another Explanation for Why Cloth Masks Reduce COVID-19 Severity
It ’s not just the mask, it’s the humidity created inside the mask that helps protect against severe COVID-19, a recent study by National Institutes of Health (NIH) researchers suggests. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

VA Nursing Homes ’ History of Infection Control Shortcomings
Virtually all nursing homes owned and operated by the Department of Veterans Affairs (VA) were cited for infection control deficiencies during the 5 fiscal years before the novel coronavirus pandemic, according to a recent Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

HHS Expands Number of People Who Can Vaccinate Against COVID-19
The US Department of Health and Human Services (HHS) recently added more categories of individuals qualified to prescribe, dispense, and administer COVID-19 vaccines. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

The Coronavirus Pandemic 1 Year On —What Went Wrong?
January 30, 2021, marked the first anniversary of the declaration by the World Health Organization (WHO) of COVID-19 as a public health emergency of international concern (PHEIC). Thus far, the world has been no match for SARS-CoV-2, with more than 100 million cases and 2.5 million deaths. The US has been among the world ’s poorest performers in addressing the pandemic, with more than 500 000 deaths. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Beware, the Sporothrix
Lying “under the haystack fast asleep,” Little Boy Blue of nursery rhyme fame could not have suspected that he might become infected by the Sporotrichum schenckii. Clearly, like the rest of us, he has been lulled into believing that, unlike marsh hay, prairie hay does not harbor this fungus. Dahl and associates (p 1980) disabuse us of this notion. They report from Kansas an outbreak of lymphocutaneous sporotrichosis involving nine children who had been playing among bales of prairie hay, which were later proved to be contaminated by the Sporotrichum. Not only is the report the first to incrimina te a hitherto u...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Association Between Proportion of Black Patients Cared for at Hospitals and Penalties in CMS Value-Based Payment Programs
This study evaluates whether US hospitals with mostly Black patients are more likely than other hospitals to have penalties associated with Centers for Medicare& Medicaid Services (CMS) value-based payment programs. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Association of Clinician Minority Patient Caseload With Performance in the 2019 Medicare MIPS
This study assesses the association between US clinicians ’ caseload of minority patients and their 2019 Medicare Merit-based Incentive Payment System performance score. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Review of Hearing Loss in Children
To the Editor The article by Dr Lieu and colleagues about hearing loss in children notably omitted the important topic of noise-induced hearing loss. Prevention of disease is almost always better and less expensive than treatment. The only treatment currently available for hearing loss is amplification, via hearing aids, personal sound amplification products, or cochlear implants. Hearing loss with age, which is predominantly due to noise-induced hearing loss, begins at an early age and is theoretically preventable with avoidance of loud noise. The only evidence-based noise exposure level to prevent noise-induced hearing l...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis
To the Editor In the article by Dr Arkell and colleagues, a few questions need clarification regarding the short-term driving test impairment with vaporized THC-dominant cannabis and THC/CBD-equivalent cannabis compared with placebo. First, did the primary outcome vary by sex or by history of driving under the influence of cannabis, which represented 20% of the participants? Second, did the primary outcome differ by recent episodes of cannabis use or by distance driven in the last year? (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis
To the Editor We wish to discuss the effects of CBD and THC on visual function, which may influence driving but may not be detected by road-tracking tests as performed in the article by Dr Arkell and colleagues. A double-blind study reported that 15 mg of THC produced transient color discrimination impairment in the blue and red to yellow region of the color circle, while 8 mg of THC and placebo did not impair color discrimination ability. This transient color perception impairment may impair the development of numerous adaptations that individuals with congenital color defects use, such as memorization of the order of tra...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis
To the Editor We read with interest the recent findings reported by Dr Arkell and colleagues concerning the effect of vaporized Δ9-tetrahydrocannabinol (THC)–dominant and THC/cannabidiol (CBD)–equivalent cannabis on on-road driving performance. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Review of Hearing Loss in Children —Reply
In Reply We appreciate the attention that Dr Fink brings to the issue of noise-induced hearing loss. In our Review of pediatric hearing loss, we chose to focus on the developments germane to children specifically and did not delve into noise-induced hearing loss, which has a growing body of literature that is not yet specific to children. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research